EXERCISE-BASED PERFORMANCE ENHANCEMENT ... - Movement … · Exercise-based performance enhancement and injury preven-tion for firefighters: Contrasting the fitness- and movement-related

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EXERCISE-BASED PERFORMANCE ENHANCEMENT AND

INJURY PREVENTION FOR FIREFIGHTERS:CONTRASTING THE FITNESS- AND MOVEMENT-RELATED

ADAPTATIONS TO TWO TRAINING METHODOLOGIES

DAVID M. FROST,1 TYSON A.C. BEACH,1 JACK P. CALLAGHAN,2 AND STUART M. MCGILL2

1Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; and 2Department ofKinesiology, University of Waterloo, Waterloo, Ontario, Canada

ABSTRACT

Frost, DM, Beach, TAC, Callaghan, JP, and McGill, SM.

Exercise-based performance enhancement and injury preven-

tion for firefighters: Contrasting the fitness- and movement-

related adaptations to two training methodologies. J Strength

Cond Res 29(9): 2441–2459, 2015—Using exercise to

enhance physical fitness may have little impact on performers’

movement patterns beyond the gym environment. This study

examined the fitness and movement adaptations exhibited by

firefighters in response to 2 training methodologies. Fifty-two

firefighters were assigned to a movement-guided fitness

(MOV), conventional fitness (FIT), or control (CON) group.

Before and after 12 weeks of training, participants performed

a fitness evaluation and laboratory-based test. Three-

dimensional lumbar spine and frontal plane knee kinematics

were quantified. Five whole-body tasks not included in the inter-

ventions were used to evaluate the transfer of training. FIT and

MOV groups exhibited significant improvements in all aspects of

fitness; however, only MOV exhibited improvements in spine and

frontal plane knee motion control when performing each transfer

task (effect sizes [ESs] of 0.2–1.5). FIT exhibited less controlled

spine and frontal plane knee motions while squatting, lunging,

pushing, and pulling (ES: 0.2–0.7). More MOV participants

(43%) exhibited only positive posttraining changes (i.e.,

improved control), in comparison with FIT (30%) and CON

(23%). Fewer negative posttraining changes were also noted

(19, 25, and 36% for MOV, FIT, and CON). These findings

suggest that placing an emphasis on how participants move

while exercising may be an effective training strategy to elicit

behavioral changes beyond the gym environment. For

occupational athletes such as firefighters, soldiers, and police

officers, this implies that exercise programs designed with

a movement-oriented approach to periodization could have

a direct impact on their safety and effectiveness by engraining

desirable movement patterns that transfer to occupational tasks.

KEY WORDS program design, learning, coaching

INTRODUCTION

Designing interventions to enhance physical fit-ness characteristics (e.g., muscular strength) orto change movement strategies (e.g., lifting tech-nique) can yield successful results when the spe-

cific objectives are defined. For example, scientists have usedtargeted interventions to reduce the knee abduction momentin females performing a drop jump (28), alleviate patellofe-moral pain in runners (31), lower spinal moments duringlifting (21), and improve performance in weightlifting exer-cises such as the clean (35) and snatch (38). However, recentevidence has shown that improvements in strength (15) orjoint range-of-motion (27) in isolation may have little influ-ence on how someone performs an unrehearsed whole-bodytask. And even when movement-based adaptations areachieved with specific biofeedback techniques, it is not guar-anteed that these changes will “transfer” to tasks that arekinematically similar (31). As a result, for the purpose ofpreventing musculoskeletal injuries and improving perfor-mance within populations that are exposed to highly vari-able task demands (e.g., athletes, firefighters, and militaryservice personnel), it could be questioned whether conven-tional approaches to exercise are sufficient.

To facilitate motor learning, retention, and the transfer oftraining, it has been suggested that movements be performedthat largely replicate the tasks of interest (2). For firefighters,this would imply that various high-risk physically demand-ing job tasks be simulated in a training environment.Although such an approach is logical, frequent exposure tojob task simulations could elevate the firefighter’s risk ofinjury if they lacked the requisite physical ability (e.g.,strength, endurance, and aerobic capacity) or awareness(e.g., recognition of ergonomic hazards) to perform safely

Address correspondence to David M. Frost, [email protected].

29(9)/2441–2459

Journal of Strength and Conditioning Research� 2015 National Strength and Conditioning Association

VOLUME 29 | NUMBER 9 | SEPTEMBER 2015 | 2441

Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.

and effectively. This suggests that although improving phys-ical fitness may be necessary, it could be insufficient toenhance performance and reduce the risk of occupationalinjury. As such, perhaps exercise should be considered notonly as a tool to enhance performance through improve-ments in physical fitness but also a means to stabilize “key”kinematic features that are generalizable across a range oftasks and have been linked to a lower injury risk (e.g., frontalplane knee motion control during fireground- and gym-related activities). Viewed in this way, firefighters could thenuse exercise to develop the physical ability and awareness tosafely and effectively meet the variable demands of theirwork.

Although the degree to which training transfers may beindividual-, task-, and program-specific, learning to safelyand effectively perform various general exercises could (inprinciple) influence how unrehearsed tasks are performed. Inturn, this may also reduce the trainee’s risk of sustaining anoccupation- or exercise-related injury. However, to achievethis objective, an emphasis should likely be placed on en-graining specific yet generalizable movement features thathave been shown to influence joint loading [e.g., spine flex-ion (7) and frontal plane knee motion (16)] while exercising.It was this premise and the high prevalence of musculoskel-etal injuries in the fire service that motivated this investiga-tion. The objective was to compare fitness- and movement-related adaptations (i.e., spine and frontal plane knee motioncontrol) between career firefighters exposed to 2 differentexercise strategies. The first approach was modeled asa high-intensity exercise program focused specifically onimproving physical fitness, whereas the other aimed toenhance physical fitness and movement awareness concur-rently (i.e., the firefighters were discouraged through instruc-tion and feedback from using potentially “risky” movementpatterns, whereas the number of repetitions, load lifted, orset duration was progressed in a periodized fashion). Thepre- and post-training spine and frontal plane knee motionwere compared with 5 occupationally relevant transfer tasksthat were unrehearsed during the 12-week training.

METHODS

Experimental Approach to the Problem

Career firefighters completed a comprehensive fitness testand a movement evaluation, comprising a battery of whole-body tasks performed with varying loads and speeds, whileinstrumented for quantitative motion analysis. On comple-tion of the 2 testing sessions, they were randomly assigned toa movement-guided fitness, fitness, or control group. Bothtraining interventions comprised 12-week periodized exer-cise programs designed to improve firefighter fitness butdiffered most notably with regard to the attention placed onhow each exercise was performed (kinematically). Partici-pants attended three 1.5-hour sessions each week and werecoached by the National Strength and Conditioning Associ-ation (NSCA)-accredited professionals. Within 1 week ofcompleting the 12-week protocol, participants returned fora second fitness and movement evaluation. The battery oftasks served as transfer tests to evaluate the movement-related adaptations to training (no formal coaching or feed-back was provided). Select descriptors of motion that havebeen previously implicated as possible mechanisms of injurywere used for comparative purposes.

Subjects

Seventy-five men from the Pensacola Fire Department wererecruited to participate. All men were free of musculoskeletalinjury or pain at the time of testing and on full active duty.Because of the time commitment required, 15 were unable toparticipate in the movement evaluation and 4 withdrewbefore completing their 12 weeks of training. An additional 4data sets were lost because of equipment malfunction,leaving 52 participants who completed pre- and posttesting.The mean (SD) age, height, body mass, and FunctionalMovement Screen (FMS) score of the participants complet-ing the pre- and postfitness and movement tests aredescribed in Table 1. The FMS is a qualitative whole-bodymovement–based screen that has demonstrated some effi-cacy in the prediction of injuries (23) and is currently beingused to help guide the design of exercise programs for

TABLE 1. The mean (SD) age, height, body mass, and Functional Movement Screen score for participants completingthe pre and post fitness (N = 66) and laboratory-based testing (N = 52) sessions.*

Sample Group (N) Age (y) Height (m) Body Mass (kg) FMS score

Fitness testing Movement (23) 39.3 (10.5) 1.81 (0.06) 89.4 (14.2) 12.9 (2.7)Fitness (19) 35.1 (10.0) 1.80 (0.07) 89.9 (13.2) 12.8 (1.7)Control (24) 38.9 (9.4) 1.79 (0.05) 92.6 (15.6) 12.9 (2.4)

Laboratory testing Movement (21) 38.7 (10.4) 1.81 (0.06) 89.6 (14.7) 13.0 (2.8)Fitness (16) 35.9 (9.7) 1.80 (0.07) 91.6 (13.4) 12.4 (1.5)Control (15) 38.3 (9.3) 1.80 (0.06) 96.0 (15.2) 12.9 (2.9)

*The characteristics described are of each intervention group before training.

Movement and the Transfer of Training

2442 Journal of Strength and Conditioning Researchthe TM


athletes and firefighters (22,32). The composite FMS scorewas used in this study strictly as 1 factor considered in theassignment of study participants to the 3 groups before train-ing to ensure an even distribution of scores. The Universityof Waterloo’s Office of Research Ethics, the Baptist HospitalInstitutional Review Board, and the City of Pensacola eachapproved the investigation, and all participants gave theirinformed consent before the data collection began.

Test Selection

Fitness Evaluation. In accordance with the InternationalAssociation of Fire Fighters’ (IAFF) Wellness and FitnessInitiative (19), 6 components of general fitness were evalu-ated: (a) body composition—estimated using the sum of 7skinfolds and generalized equations for predicting body fatpercentage (20); (b) aerobic capacity—estimated with theGerkin treadmill protocol (13); (c) muscular strength—gripstrength was measured with a hand dynamometer (14); (d)muscular endurance—evaluated with a combination ofdynamic (i.e., maximum push-ups) and static (i.e., frontplank, side plank, and Biering-Sorensen) tests (26); (e)lower-body power—estimated using countermovement jumpheight (19); and (f ) flexibility—assessed with the modified sit-and-reach (19). The specific details of each test weredescribed to participants using a series of standardized in-structions; however, a formal familiarization protocol wasnot used.

Movement Evaluation. The 5 transfer tests were chosen toreflect commonly performed whole-body tasks that imposesimilar movement demands to those experienced by fire-fighters while on-duty (e.g., challenge control of spine flexionwhile lifting and pulling). The 5 tasks were (a) lift—fromstanding, a box (0.33 3 0.33 3 0.28 m) was lifted from thefloor to waist height; (b) squat—a body weight squat wasperformed; (c) lunge—a forward lunge was performed withthe right leg; (d) push—from a split stance (left leg forwards),a standing press was performed with the right arm; (e) pull—from a split stance (left leg forwards), a standing pull wasperformed with the right arm.

Experimental Protocol

Fitness Testing. A registered dietician recorded participants’height, body mass and conducted the skinfold assessment.The fitness test was then administered by an NSCA-accredited strength and conditioning professional using 8standardized procedures. (a) Participants performed a gradedtreadmill test (13). After 3 minutes at 4.8 km$h21 (0% grade)and 1 minute at 7.2 km$h21 (0% grade), the speed or inclinewas raised every minute (0.8 km$h21 or 2% grade) untilvolitional fatigue. Treadmill time was used as a surrogateof aerobic capacity. Twenty minutes of rest was given beforethe next test. (b) Participants performed 3 sit-and-reach trialswhile seated on the floor with their legs extended and feetflat against the sit-and-reach box. (c) Grip strength was mea-sured using a hand dynamometer (Takei Kiki Kogyo, Nigata,

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essInitiative.*†

Group

(N)

BOD

(%)

TRD

(s)

LPK(s)

RPK(s)

FPK(s)

EXT(s)

LGP(kg)

RGP(kg)

PSH

(rep

s)CMJ(cm)

SIT

(cm)

Movemen

t(23)

21.4z(

2.2)

62.4z(

52.5)

9.0

(31.0)25.5

(42.8)47.5z(

30.4)35.1z(

33.1)2.0z(

3.9)2.0z(

4.7)13.8z(

8.4)

2.6z(

3.3)

4.4z(

4.5)

Fitn

ess

(19)

21.3z(

2.3)

88.6z(

66.6)

21.2z(

29.5)

11.1

(32.3)63.7z(

57.4)50.8z(

35.1)1.9z(

3.3)

1.3

(5.1)25.6z(

11.5)

2.6z(

3.4)20.3

(4.6)

Control

(24)

0.2

(1.5)222.6

(57.4)210.8

(39.0)24.0

(24.9)

5.6

(36.7)

25.6

(22.4)1.8z(

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1.4

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;LGP=leftgrip

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push-

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CMJ=vertical

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Journal of Strength and Conditioning Researchthe TM

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Japan) while participants sat with their shoulder adducted,elbow flexed to 908, and wrist in a neutral position. Threemaximal effort trials were performed with each hand. (d)Countermovement jump height was evaluated with a VertecJump Measuring Device (Gill Athletics, Champaign, IL,USA). Three maximal effort trials were performed. (e)Push-ups were performed until volitional fatigue while main-taining a neutral spine. A 0.10-m thick pad was placedbeneath the chest to provide a target depth. The test wasterminated when the arms could no longer be extended or

the required depth was not achieved. (f ) Trunk flexor endur-ance was established with a front plank. The test was termi-nated when an extended hip position or neutral spineposture could no longer be maintained. (g) A side plankwas used as a second measure of trunk muscle endurance.The test was terminated when a straight-body position couldno longer be maintained. (h) Trunk extensor endurance wasestimated using the Biering-Sorensen test. The test was ter-minated when the body could no longer be held in a positionparallel to the floor. Approximately 2 minutes of rest was

Figure 1. Lift- and squat-specific adaptations in peak spine and knee motion for each condition (load 3 speed) and group. Changes are presented asa function of the maximum within-subject variation + 1SD and depict those exhibited during the descent phase of each task (ascent was similar). The effect size(ES) of each difference is also described by the inclusion of 1 (ES = 0.2–0.5) or 2 (0.5–0.8) asterisks. A positive change reflects less motion posttraining. Themodel animations highlight the pre-post changes observed for 1 participant from the MOV group. Data are presented for the low-load/low-velocity (LLLV), low-load/high-velocity (LLHV), high-load/low-velocity (HLLV), and high-load/high-velocity (HLHV) conditions.




given between each task. Participants’ best performance oneach test was used for comparative purposes.

Movement Testing. Participants were instrumented withreflective markers and familiarized with the 5 tasks usingstandardized instructions. The initial exposure to each taskreflected a low external demand; the load and movementspeed were low (LLLV—low load, low velocity). The liftswere performed with 6.8 kg, the squats and lunges werecompleted with body weight, and the push and pull loads(Keiser, Fresno, CA, USA) were set at 4 kg (15 units onKeiser display) and 6.5 kg (20 units), respectively. Threerepetitions of each task were performed. The 5 tasks wererandomized and approximately 15- and 60-second rest weregiven between each repetition and task, respectively. Onceall tasks had been completed, the movement speed andexternal load were modified in 3 ways: (a) low load, highvelocity (LLHV)—increase in movement speed only; partic-ipants were asked to complete each repetition as fast as wascomfortable; (b) high load, low velocity—increase in external

load only; the lifts were performed with 22.7 kg, the squatsand lunges were performed with an 18.2-kg weighted vest,and the push and pull loads were set at 9.8 kg (30 units) and13.6 kg (40 units), respectively; (c) high load, high velocity—increase in movement speed and external load. Each load/speed condition was performed sequentially based on theexpected musculoskeletal demands. No feedback was givenregarding task performance at any point throughout theinvestigation.

Training. After baseline testing, participants were assigned(stratified randomization) to one of the 3 groups, eachmatched for age, height, body mass, and composite FMSscore: (a) movement-guided fitness training (MOV), (b)conventional fitness training (FIT), or (c) control (CON).The 2 interventions comprised 12-week, periodized exerciseprograms (MOV—4 phases, FIT—3 phases) designed toimprove general fitness characteristics (e.g., aerobic capacity)and performance outcomes (e.g., treadmill time), but differedwith regard to the selection of exercises, intensities, and

Figure 2. Lunge-specific adaptations in peak spine and knee motion for each condition (load 3 speed) and group. Changes are presented as a function of themaximum within-subject variation + 1SD and depict those exhibited during the descent phase (ascent was similar). The effect size (ES) of each difference is alsodescribed by the inclusion of 1 (ES = 0.2–0.5), 2 (0.5–0.8), or 3 (.0.8) asterisks. A positive change reflects less motion posttraining. The model animationshighlight the pre-post changes observed for 1 participant from the MOV group. Data are presented for the low-load/low-velocity (LLLV), low-load/high-velocity(LLHV), high-load/low-velocity (HLLV), and high-load/high-velocity (HLHV) conditions.


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training volumes (see Appendix), and the instruction andfeedback provided by the coaches regarding how each exer-cise should be performed. This was done to contrast 2 dis-similar training methodologies, each intended to elicitdifferent exercise adaptations, rather than to investigate theinfluence of any 1 specific factor such as volume, intensity, orcoaching style. Throughout the 12 weeks, the MOV coachused instruction and feedback to reinforce “key” movementfeatures that have been hypothesized or demonstrated toreduce injury risk (7,16,17,25). For example, the firefighterswere made aware of the potential implications surrounding

uncontrolled spine motion while executing all relevant exer-cises, and they were given cues to shape their movementbehavior accordingly (see Appendix). When performinga front plank, front squat, or overhead press, the firefighterswere taught how to achieve and maintain a “neutral” spine(i.e., the posture in which the spine’s load-bearing capacity isnear maximum). Effectively, the same “key” movement fea-tures, such as neutral spine and frontal plane knee alignment,were emphasized with every exercise such that the fire-fighters’ movement patterns remained a primary focus astheir muscular strength, power, flexibility, endurance, and

Figure 3. Push- and pull-specific adaptations in peak spine and knee motion for each condition (load 3 speed) and group. Changes are presented asa function of the maximum within-subject variation + 1SD and depict those exhibited during the first phase of each task (i.e., pushing away and pulling toward thebody). The effect size (ES) of each difference is also described by the inclusion of 1 (ES = 0.2–0.5), 2 (0.5–0.8), or 3 (.0.8) asterisks. A positive changereflects less motion posttraining. The model animations highlight the pre-post changes observed for 1 participant from the MOV group. Data are presented forthe low-load/low-velocity (LLLV), low-load/high-velocity (LLHV), high-load/low-velocity (HLLV), and high-load/high-velocity (HLHV) conditions.




cardiorespiratory efficiency were being enhanced in a pro-gressive manner. Conversely, the primary objective of theFIT program was to make the firefighters as physically “fit”as possible. Exercise technique was monitored and feedbackwas provided when necessary for safety purposes, but thecoach’s emphasis was on maximizing performance and fit-ness outcomes in the gym environment. This mimicked theapproaches of many popular high-intensity programswhereby the coach or trainer encourages the trainee to com-plete a specific number of repetitions or lift a particular loadwith little regard for the quality of their movement or thetransfer of training.

Participants in both groups attended three 1.5-hoursessions each week at a local training facility and werecoached by strength and conditioning professionals ac-credited by the NSCA. Trainees were asked to refrain fromperforming any additional exercise for the duration of theinvestigation. At no time were the specific objectives of theevaluations, the differences between each training group, orthe study hypotheses discussed with the participants. Thefirefighters were asked to perform a battery of fitness testsand whole-body tasks in a laboratory setting before and afterparticipating in a 12-week exercise program designed toimprove their physical fitness. The coaches were alsoblinded to the laboratory-based testing protocols andinstructed to refrain from sharing their thoughts regardingthe test/study objectives with their group of firefighters.Participants were required to attend 30 of the 36 trainingsessions to be included in the analyses. Within 1 week ofcompleting training (week 13), the firefighters returned fora second fitness and movement test. The CON participantswere asked to maintain their current fitness regime for 12weeks before returning to complete posttesting.

Data Collection and Signal Processing

During the laboratory session, three-dimensional motiondata were measured using a passive motion capture system(Vicon, Centennial, CO, USA). Reflective markers wereplaced on 23 anatomical landmarks to assist in definingthe end points of the trunk, pelvis, thighs, shanks, and feet todefine an 8-segment rigid link model. The hip joint centersand knee joint axes were also determined “functionally”using similar methods to those described by Begon et al.(3) and Schwartz and Rozumalski (36). This method hasbeen shown to improve the day-to-day reliability of thelinked segment model (12). Sets of 5 markers, fixed to rigidpieces of plastic, were secured to the 8 body segments (i.e.,trunk, pelvis, thighs, shanks, and feet) with Velcro straps andused to track their position and orientation in space. Thepelvis cluster was secured to a custom belt worn throughouttesting at the level of the sacrum, and the trunk cluster wasfixed to a custom vest at the inferior border of the rib cage.One standing calibration trial was collected such that theorientation of each segment’s local axis system could bedetermined through a transformation from an axis system

embedded within each rigid body. The anatomical markerswere removed once the calibration procedures were com-pleted. The marker data were collected at 160 Hz andsmoothed with a low-pass filter (fourth order dual-passButterworth) with an effective cut-off frequency of 6 Hz.

Data Analyses

Participants’ movement patterns were characterized with 5variables, each chosen to reflect a visually observable featurethat has been previously cited as a possible mechanism forlow back (7,25) or knee (16,17) injury. Visually observablecharacteristics were preferred given that the MOV coachbased his instruction and feedback on these same character-istics. Spine flexion/extension (FLX), lateral bend (BND),and axial twist (TST) were computed by expressing the rel-ative orientation of the rib cage with respect to the pelvis.The corresponding direction cosine matrix was decomposedwith a Cardan rotation sequence of flexion/extension, lateralbend, and axial rotation to compute the spine angle abouteach axis. The orientation of the lumbar spine capturedwhile standing in the anatomical position was defined aszero degrees. The positions of the left (LFT) and right knee(RGT) joint center in the medial/lateral direction weredescribed relative to a body-fixed plane created using thecorresponding hip joint, ankle joint, and distal foot (10).

To objectively define the start and end of each trial, eventdetection algorithms were created in Visual 3D by trackingthe motion of the trunk, pelvis, right forearm (push and pull),and whole-body center of mass. To verify that events weredefined as intended, model animations of all trials wereinspected visually. Maximums and minimums of the 5kinematic variables were computed. The “peak” of each vari-able was described as the deviation (maximum, minimum, orrange) hypothesized to be most relevant to the types of in-juries sustained by firefighters (i.e., FLX—flexion, BND andTST—range, LFT and RGT—medial displacement). For thepurpose of this investigation, less motion posttraining wasconsidered a positive adaptation indicative of improvedcontrol.

Statistical Analyses

The fitness-related adaptations to training were evaluatedusing a general linear model with 1 between- (group) and 1within-subject (time) factor (Version 20.0; IBM SPSS Statis-tics, Armonk, NY, USA). Tukey post hoc comparisons wereused to investigate the main effects and all significantinteractions (p # 0.05).

Participants’ movement-related adaptations were evalu-ated using the biological variability computed between andwithin the subjects. Two measurements were used todescribe the magnitude of each pre-post change. An effectsize (ES) was computed to describe the pre-post differencesin FLX, BND, TST, LFT, and RGT relative to the pooledbetween-subject variation. An ES of one indicated that thepre-post difference was equal to the variation observedbetween participants. A positive effect implied that less


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motion was observed posttraining. A within-subject normal-ized difference (WND) was computed to express the pre-post differences relative to the maximum variation observedwithin participants (61SD of the group mean). The maxi-mum variability computed for any metric (i.e., max, min, ormean) or condition (e.g., LLLV) was used in this computa-tion. The same approach was also used to examine thesubject-specific responses for each dependent measure (11).A score greater than one or less than negative one indicatedthat the individual’s posttraining change was greater thanthe average variability observed within participants(61SD). A change of this magnitude is defined herein asa biologically significant change (11). Each load/movementspeed condition was investigated separately. The strength ofeither variable was interpreted using the general guidelinesoffered by Cohen (8) for ES, whereby values of 0.2, 0.5, and0.8 corresponded to small, moderate, and large changes,respectively.

RESULTS

Fitness Adaptations

Posttraining, the movement group showed significant im-provements (p # 0.05) on every measure of fitness with theexception of the left and right side plank (Table 2). Similarly,the fitness-trained participants improved (p # 0.05) everyaspect of fitness with the exception of their flexibility, aswas measured by the sit-and-reach (Table 2). The controlgroup showed significant improvements on 2 of the 11 tests(left grip and max push-ups); however, in each case, themagnitude of change was smaller than that observed foreither of the training groups.

Movement Adaptations

Lifting. The most substantial lifting adaptations were ex-hibited by the movement group (Figure 1). Less FLX wasexhibited in each of the load/movement speed conditions(WND .0.5; ES .0.3 for 3 of 4 conditions). A similar trendwas noted for LFT and RGT, although the only changeswith an ES and WND greater than 0.2 were RGT duringthe low-load/high velocity and high load/low velocity con-ditions. The fitness-oriented intervention did not elicit anychanges to the group’s lifting pattern. In comparison, thecontrol group exhibited 5 changes with a WND greater than0.2, although each reflected a negative response with anincrease in motion posttraining.

Squatting. The movement group showed marked improve-ments in LFT and RGT for each condition, although onlyRGT had a WND and ES greater than 0.3 (Figure 1). Thelargest posttraining changes (WND .0.6; ES .0.5) in RGTwere seen during the high-load/high-velocity condition. Anegative change in FLXwas noted during the low-load/low-velocity condition (WND .0.4; ES .0.2); however, similaradaptations were not found with any other load/movementspeed combination. Among the conventional fitness-training

group, marked increases in FLX were observed across allconditions (WND .0.9; ES .0.4). A similar negativeresponse was noted in LFT and RGT, although the magni-tudes of change were much smaller and not consistent acrossall conditions. Control group participants did not exhibit anychanges during their second testing session.

Lunging. The movement group exhibited improvements inFLX, BND, and TST across all conditions, albeit to varyingdegrees (Figure 2). The largest adaptations were observed forBND (WND .0.5; ES .0.5) and TST (WND .0.6; ES.0.8), and the posttraining changes in FLX and TSTappeared to be speed dependent; greater adaptations wereseen during the high-speed conditions. A positive changewas noted in RGT during low load/low velocity (WND.0.3; ES .0.2). The fitness group also improved their abilityto control BND and TST posttraining. However, unlike themovement group’s participants, they performed the lungewith more FLX (WND .0.5; ES .0.2 during LLHV) andRGT (WND .0.3; ES .0.2 across conditions) posttraining.Notable changes in FLX and BND were also seen among thecontrol group; however, in each case, they were negative.

Pushing. The movement group exhibited positive changesexceeding a WND of 1.4 and an ES of 0.8 in BND and TST(Figure 3). The movement-guided fitness intervention ap-peared to have little influence on FLX and LFT. The con-ventional fitness group exhibited similar posttrainingchanges in BND (WND .0.3; ES .0.2) and TST (WND.0.9; ES .0.5), although they also displayed negativechanges in FLX (WND .0.6; ES .0.3) and LFT (WND.0.3; ES .0.3). The control group did not consistentlyexhibit significant changes in either direction.

Pulling. The most notable changes among the movementgroup were those seen in TST (WND .1.2; ES .0.6). Theposttraining adaptations to FLX and BND were also posi-tive, but the magnitude of change was not consistent acrossconditions (Figure 3). The movement-guided interventionappeared to have had a speed-dependent effect on LFT;the largest improvements were noted during low-load/high-velocity and high-load/high-velocity conditions(WND .0.6; ES .0.2). The conventional fitness interven-tion evoked similar improvements in TST, although the larg-est changes were seen when the pull was performed quickly(WND .1.3; ES .0.6). Positive changes in BND were seenduring the 2 heavy conditions (WND .0.3; ES .0.4); how-ever, as with the squat, lunge, and push, the fitness-orientedgroup also displayed more FLX and LFT posttraining. Thecontrol group did not consistently exhibit changes in eitherdirection for any dependent measure.

Subject-Specific Adaptations

More movement group’s participants exhibited significantchanges (i.e., WND .1.0) in FLX, BND, TST, LFT, andRGT for each task, in comparison with the conventional




fitness and control groups. Expressed as a percentage of thenumber of subjects in the group, averaged across variables,and tasks, 43% of all movement participants exhibited onlypositive biologically significant changes posttraining. This isin comparison with 30 and 23% for the fitness and controlparticipants, respectively. The movement group also had thefewest number of participants exhibiting more spine andfrontal plane knee motion posttraining. Expressed as per-centage of the total number of participants, 19% of themovement group’s participants showed only negative signif-icant changes, in contrast to 26 and 36% from the fitness andcontrol groups, respectively.

DISCUSSION

The firefighters participating in both exercise interventionsdisplayed significant changes in every aspect of physicalfitness tested. However, only the MOV group membersexhibited less spine and frontal plane knee motion whileperforming the 5 transfer tasks posttraining. Select FITparticipants did show some improvement in these samemeasures, although the general tendency of those whocompleted the FIT program was to use movement strategiescomprising more spine and frontal plane knee motion afterthe exercise intervention. This finding suggests that perhapsthe physical preparation of firefighters, or any other high-risk occupational or athletic group, is likely unattainable byemphasizing improvements on general tests of physicalfitness alone.

Being physically fit may play a role in the prevention offuture injury (6,24), but alone it is likely insufficient for thispurpose, given that the way in which movements are coor-dinated and controlled influences musculoskeletal loading.For example, poor torso extensor endurance has been citedas a marker for future low back trouble in men (4); yet, thesources of low-back pain may not be muscular in nature.Rather, superior trunk muscle endurance could provide theopportunity to control spinal alignment for extended periodsof time by delaying fatigue-induced deficits in neuromuscu-lar control (37). But, if an individual is unable (e.g., proprio-ception deficits unrelated to fatigue process) or does not(e.g., personal preference or learned behavior) control themotion of their spine for reasons other than lack of muscularendurance, the risk of developing low-back disorders may beunaffected by improving trunk muscle endurance. Indeed,members of the FIT group displayed superior trunk muscleendurance posttraining; yet, they also exhibited significantlygreater spine flexion when executing squatting movements.Similarly, Hilyer et al. (18) found that improving flexibility infirefighters did not reduce their injury risk, perhaps becauseaddressing joint range of motion in isolation will not neces-sarily lead to “functional” changes (27). Furthermore, “plyo-metric” and “core strengthening” programs, designed toimprove various components of physical fitness withoutthe provision of movement-oriented instruction/feedback,have been unable to consistently reduce the incidence of

anterior cruciate ligament injury (33) and low-back pain(5,30), respectively. A firefighter’s job is physically demand-ing, and they must be physically fit to meet the demands oftheir work without suffering adverse health outcomes (e.g.,cardiac events). However, being physically fit is unlikely suf-ficient to reduce injury risk among these public protectorsgiven that movement behaviors and musculoskeletal loadingpatterns are affected by a host of interacting individual, task,and environmental constraints (9).

To address the incidence of exercise-related injuriesamong firefighters (34) and establish a framework to furtherdevelop and implement in future work, the MOV coachfocused his attention on the motions exhibited by traineeswhen they were exercising. Several critical observations(“key” kinematic features) that have been linked to reducedtissue loading and the prevention of musculoskeletal injury(e.g., control of frontal plane lower extremity alignment (16))were (re)enforced through instruction and feedback duringtraining. Without providing explicit instruction regarding theexecution of each transfer task, improvements in spine andfrontal plane knee motion control were noted posttraining infirefighters who received this type of coaching. This suggeststhat movement behavior and physical fitness adaptations canbe elicited through a movement-oriented exercise approach.Using exercise to target the motion patterns that drive ele-vated joint loading has been hypothesized as one of the mosteffective training strategies to protect against future anteriorcruciate ligament injury (29). However, to the authors’knowledge, this is the first study to use this type of trainingmethodology to elicit movement-related changes across sev-eral unrehearsed tasks of varying demands.

To become more proficient with a particular motor skill, beit a job task or exercise, it is often suggested that you mustrepeatedly perform the specific skill (2). However, without thephysical capacity (e.g., strength, endurance, etc.) or bodyawareness to perform safely and effectively, practicing a taskdoes not guarantee that trainees will use low-risk movementstrategies. Moreover, leaving “risky” movement behaviorunchecked during training could eventually result in cumula-tive tissue damage. This may be one of the reasons why a largepercentage of the training-related injuries sustained by fire-fighters (34) and soldiers (1) are categorized as being of theoveruse variety. In an effort to become better physically pre-pared, they could be engraining movement behaviors thatincrease their risk of future injury. Because the FIT partici-pants were not provided with explicit feedback regarding thecritical aspects of their motions while performing each exer-cise, they may have spent 12 weeks reinforcing undesirablepatterns of movement coordination and control. As a result,when tested posttraining, their performance might have re-flected their practiced behaviors. In contrast, the MOV par-ticipants may have exhibited less spine and frontal plane kneemotion posttraining because they were provided with explicitinstruction and feedback pertaining to their movementsthroughout, although it is acknowledged that the influence


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of coaching cannot be isolated from the selection of exercises,training intensities, and volume of loading.

Results of this investigation lend support to the notionthat exercise can be used to change movement behavior,provided that movement-oriented instruction and feedbackis offered when exercising. However, it should be noted thatno 2 participants responded in the same way across all tasksand conditions. More firefighters from the MOV interven-tion did exhibit positive changes posttraining in comparisonwith those from FIT, but the group adaptations did notreflect those of all participants. For example, every firefighterparticipating in FIT did not exhibit more spine flexion whilesquatting, as was seen in the group response. It must also bestated that each participant did not perform in the samemanner before they began training. Certain firefighters ex-hibited little spine and frontal plane knee motion when firstperforming each of the transfer tasks and may therefore haveshown minimal change, despite the fact that their movementpatterns would be perceived by an observer as “good.” Giventhe possibility that many participants had never consideredhow to coordinate and control their movements when exer-cising, it is also conceivable that the instructions and feed-back caused some individuals to focus on a single aspect oftheir movement, thereby neglecting one or more of the other“key” features. This may also have been influenced by their(un)familiarity with the exercises performed, as the partici-pating firefighters had a range of prior experiences. Becausethere are several plausible explanations for why the group’sresponse was not indicative of each participant, in futurework, it may be critical to examine each participant’s adap-tations if trying to interpret the transfer of training.

PRACTICAL APPLICATIONS

This study shows that exercise could be an effective tool toreduce musculoskeletal injury risk, provided that generaliz-able movement-oriented instructions and feedback are usedto reinforce “protective” behaviors (e.g., “maintain control offrontal plane knee motion when.”). Conversely, the datahere suggest that emphasizing physical fitness alone may notreduce occupational injury potential, as these same protec-tive movement patterns are unlikely to emerge withoutdirected efforts to transfer these exercise adaptations.Despite showing significant improvements in fitness, theFIT participants were also found to change their movementbehavior in ways that could increase the risk of sustaininga future exercise-, training-, or fireground-related injury. Thedegree to which exercise adaptations transfer is most likelyindividual-, task-, and program-specific. However, the find-ing that firefighters who received movement-oriented exer-cise instructions and feedback were less likely to use “risky”movement behaviors in unrehearsed tasks is promising.

ACKNOWLEDGMENTS

The authors thank performance coaches Anthony Hobgoodand Drew Fischer for their contributions and are grateful to

Athletes’ Performance and the Andrews Research and Edu-cation Institute for use of their facilities and support. Ath-letes’ performance also deserves further recognition for theirassistance with the design of the training interventions. Theauthors also extend their gratitude to each member of thePensacola Fire Department for their commitment to thiswork. Funding for this project was provided by the Centreof Research Expertise for the Prevention of MusculoskeletalDisorders (CRE-MSD) and the Natural Sciences and Engi-neering Research Council of Canada (NSERC). Dr. JackCallaghan is also supported by the Canada Research Chairin Spine Biomechanics and Injury Prevention. The results ofthis study do not constitute endorsement by the NationalStrength and Conditioning Association.

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33. Pfeiffer, RP, Shea, KG, Roberts, D, Grandstrand, S, and Bond, L.Lack of effect of a knee ligament injury prevention program on theincidence of noncontact anterior cruciate ligament injury. J BoneJoint Surg Am 88: 1769–1774, 2006.

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APPENDIX:

TABLE A1. The FIT training template.

Phase 1 Phase 2 Phase 3

Day 1 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 121A Trap bar deadlift 3 3 8 3 3 8 3 3 8 2 3 5 3 3 6 3 3 6 3 3 6 2 3 4 4 3 6 4 3 6 4 3 6 2 3 41B Lat pull-down/pull-up 3 3 8 3 3 8 3 3 8 2 3 5 3 3 6 3 3 6 3 3 6 2 3 4 4 3 6 4 3 6 4 3 6 2 3 41C Bench press 3 3 8 3 3 8 3 3 8 2 3 5 3 3 6 3 3 6 3 3 6 2 3 4 4 3 6 4 3 6 4 3 6 2 3 4

Rest: 60 s between sets2A DB military press 2 3 10 2 3 10 2 3 10 1 3 6 3 3 10 3 3 10 3 3 10 2 3 6 3 3 8 3 3 8 3 3 8 2 3 52B DB bent over row 2 3 10 2 3 10 2 3 10 1 3 6 3 3 10 3 3 10 3 3 10 2 3 6 3 3 8 3 3 8 3 3 8 2 3 52C Single-leg squat 2 3 10 2 3 10 2 3 10 1 3 6 3 3 10 3 3 10 3 3 10 2 3 6 3 3 8 3 3 8 3 3 8 2 3 5

Rest: 30 s between sets3A Leg extension 2 3 15 2 3 15 2 3 15 1 3 15 2 3 10 2 3 10 2 3 10 1 3 10 2 3 8 2 3 8 2 3 8 1 3 83B Hamstring curl 2 3 15 2 3 15 2 3 15 1 3 15 2 3 10 2 3 10 2 3 10 1 3 10 2 3 8 2 3 8 2 3 8 1 3 83C Abdominal curl-up 2 3 15 2 3 15 2 3 15 1 3 15 2 3 10 2 3 10 2 3 10 1 3 10 2 3 8 2 3 8 2 3 8 1 3 8

Rest: 30 s between setsCardio (run, bike, versa) 30-min low intensity 30-min low intensity 30-min low intensity

Day 2 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12

1A Squat press 2 3 15 2 3 15 2 3 20 1 3 12 2 3 25 2 3 25 2 3 30 1 3 20 2 3 35 2 3 35 2 3 40 1 3 251B Horizontal pull-up 2 3 15 2 3 15 2 3 20 1 3 12 2 3 25 2 3 25 2 3 30 1 3 20 2 3 35 2 3 35 2 3 40 1 3 251C Medicine ball slam 2 3 15 2 3 15 2 3 20 1 3 12 2 3 25 2 3 25 2 3 30 1 3 20 2 3 35 2 3 35 2 3 40 1 3 25

Rest: 45 s between sets2A Push-ups 2 3 15 2 3 15 2 3 20 1 3 12 2 3 25 2 3 25 2 3 30 1 3 20 2 3 35 2 3 35 2 3 40 1 3 252B Lunge walk 2 3 15 2 3 15 2 3 20 1 3 12 2 3 25 2 3 25 2 3 30 1 3 20 2 3 35 2 3 35 2 3 40 1 3 252C Medicine ball rotation 2 3 15 2 3 15 2 3 20 1 3 12 2 3 25 2 3 25 2 3 30 1 3 20 2 3 35 2 3 35 2 3 40 1 3 25

Rest: 45 s between sets3A Grip (squeeze) 2 3 15 2 3 15 2 3 20 1 3 20 2 3 25 2 3 25 2 3 30 1 3 20 2 3 35 2 3 35 2 3 40 1 3 253B Wrist roll 2 3 15 2 3 15 2 3 20 1 3 20 2 3 25 2 3 25 2 3 30 1 3 20 2 3 35 2 3 35 2 3 40 1 3 253C Exercise ball crunch 2 3 15 2 3 15 2 3 20 1 3 20 2 3 25 2 3 25 2 3 30 1 3 20 2 3 35 2 3 35 2 3 40 1 3 25

Rest: 45 s between setsCardio (run, bike, versa) 30-min med intensity

(work:rest—6:1 to 1:1)30-min med intensity(work:rest—6:1 to 1:1)

30-min med intensity(work:rest—6:1 to 1:1)


1A Seated leg press 2 3 30 s 2 3 30 s 2 3 30 s 1 3 30 s 3 3 30 s 3 3 30 s 3 3 30 s 2 3 30 s 3 3 45 s 3 3 45 s 3 3 45 s 2 3 30 s1B Seated chest press 2 3 30 s 2 3 30 s 2 3 30 s 1 3 30 s 3 3 30 s 3 3 30 s 3 3 30 s 2 3 30 s 3 3 45 s 3 3 45 s 3 3 45 s 2 3 30 s1C Cable row 2 3 30 s 2 3 30 s 2 3 30 s 1 3 30 s 3 3 30 s 3 3 30 s 3 3 30 s 2 3 30 s 3 3 45 s 3 3 45 s 3 3 45 s 2 3 30 s

Rest: 45 s between sets

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TABLE A2. The MOV training template.

Phase 1 Phase 2 Phase 3 Phase 4

Day 1 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 121A Upper body push 3 3 8 3 3 8 3 3 12 3 3 12 3 3 12 3 3 12 4 3 15 4 3 15 4 3 15 4 3 15 3 3 8 3 3 81B Supplemental NA NA 3 3 5 3 3 5 3 3 5 3 3 5 3 3 5 3 3 5 3 3 5 3 3 5 3 3 5 3 3 51C Lower body pull 3 3 8 3 3 8 3 3 12 3 3 12 3 3 12 3 3 12 4 3 12 4 3 12 4 3 12 4 3 12 3 3 8 3 3 81D Supplemental NA NA NA NA NA NA 3 3 8 3 3 8 3 3 8 3 3 8 3 3 5 3 3 5

Rest: 45 s between sets2A Rotation 3 3 8 3 3 8 3 3 12 3 3 12 3 3 12 3 3 12 NA NA NA NA 3 3 6 3 3 62B Supplemental 2 3 6 2 3 6 2 3 5 2 3 5 2 3 5 2 3 5 NA NA NA NA 2 3 5 2 3 5

Rest: 45 s between sets3A Upper body push 3 3 8 3 3 8 3 3 12 3 3 12 3 3 12 3 3 12 3 3 12 3 3 12 3 3 12 3 3 12 2 3 9 2 3 93B Lower body pull 3 3 8 3 3 8 3 3 12 3 3 12 3 3 12 3 3 12 3 3 12 3 3 12 3 3 12 3 3 12 2 3 9 2 3 9

Rest: 45 s between setsCardio (run, bike, elliptical) 30-min med intensity

(low, mod,high HR)

30-min med intensity(low and high HR)

30-min med intensity(low, mod, and high HR)

30-min med intensity(low, mod, and high HR)

(continued on next page)

2A Machine squat 2 3 30 s 2 3 30 s 2 3 30 s 1 3 30 s 2 3 45 s 2 3 45 s 2 3 45 s 1 3 45 s 2 3 45 s 2 3 45 s 2 3 45 s 1 3 45 s2B Shoulder press 2 3 30 s 2 3 30 s 2 3 30 s 1 3 30 s 2 3 45 s 2 3 45 s 2 3 45 s 1 3 45 s 2 3 45 s 2 3 45 s 2 3 45 s 1 3 45 s2C V-pulls 2 3 30 s 2 3 30 s 2 3 30 s 1 3 30 s 2 3 45 s 2 3 45 s 2 3 45 s 1 3 45 s 2 3 45 s 2 3 45 s 2 3 45 s 1 3 45 s

Rest: 45 s between sets3A Biceps curl 2 3 30 s 2 3 30 s 2 3 30 s 1 3 30 s 2 3 45 s 2 3 45 s 2 3 45 s 1 3 45 s 2 3 60 s 2 3 60 s 2 3 60 s 1 3 60 s3B Triceps extension 2 3 30 s 2 3 30 s 2 3 30 s 1 3 30 s 2 3 45 s 2 3 45 s 2 3 45 s 1 3 45 s 2 3 60 s 2 3 60 s 2 3 60 s 1 3 60 s3C Side plank 2 3 30 s 2 3 30 s 2 3 30 s 1 3 30 s 2 3 45 s 2 3 45 s 2 3 45 s 1 3 45 s 2 3 60 s 2 3 60 s 2 3 60 s 1 3 60 s

Rest: 45 s between setsCardio (run, bike, versa) 30-min high intensity

(work:rest—1:1 to 1:6)30-min high intensity(work:rest—1:1 to 1:6)

30-min high intensity(work:rest—1:1 to 1:6)

During the first 3 weeks of each phase, the FIT coach modified participants’ training loads such that the desired number of repetitions could be achieved with a maximal effort. Thefourth week in each phase was treated as an active recovery week (i.e., the volume of loading was halved while maintaining intensity). Exercises labeled with the same number (e.g., 1A,1B, and 1C) were performed in succession before completing a second set.


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1A Lower body push 3 3 8 3 3 8 3 3 10 3 3 10 3 3 10 3 3 10 4 3 12 4 3 12 4 3 12 4 3 12 3 3 6 3 3 61B Supplemental NA NA 3 3 5 3 3 5 3 3 5 3 3 5 3 3 6 3 3 6 3 3 6 3 3 6 3 3 5 3 3 51C Upper body pull 3 3 8 3 3 8 3 3 10 3 3 10 3 3 10 3 3 10 4 3 12 4 3 12 4 3 12 4 3 12 3 3 6 3 3 61D Supplemental NA NA NA NA NA NA 3 3 6 3 3 6 3 3 6 3 3 6 3 3 5 3 3 5


Rest: 45 s between sets3A Lower body push 3 3 8 3 3 8 3 3 10 3 3 10 3 3 10 3 3 10 3 3 12 3 3 12 3 3 12 3 3 12 2 3 7 2 3 73B Upper body pull 3 3 8 3 3 8 3 3 10 3 3 10 3 3 10 3 3 10 3 3 12 3 3 12 3 3 12 3 3 12 2 3 7 2 3 7

Rest: 45 s between setsCardio (run, bike, elliptical) 30-min low intensity

(low and mod HR)30-min low intensity(low and mod HR)

30-min low intensity(low and mod HR)

30-min low intensity(low, mod, high HR)


1A Upper/lower push 3 3 10 3 3 10 3 3 10 3 3 10 3 3 10 3 3 10 4 3 10 4 3 10 4 3 10 4 3 10 3 3 6 3 3 61B Supplemental NA NA 3 3 5 3 3 5 3 3 5 3 3 5 3 3 6 3 3 6 3 3 6 3 3 6 3 3 5 3 3 51C Upper/lower pull 3 3 10 3 3 10 3 3 8 3 3 8 3 3 8 3 3 8 4 3 10 4 3 10 4 3 10 4 3 10 3 3 6 3 3 61D Supplemental NA NA 3 3 5 3 3 5 3 3 5 3 3 5 3 3 6 3 3 6 3 3 6 3 3 6 3 3 5 3 3 5


Rest: 45 s between sets3A Lower body push 3 3 8 3 3 8 3 3 8 3 3 8 3 3 8 3 3 8 3 3 12 3 3 12 3 3 12 3 3 12 2 3 7 2 3 73B Upper body pull 3 3 8 3 3 8 3 3 8 3 3 8 3 3 8 3 3 8 3 3 12 3 3 12 3 3 12 3 3 12 2 3 7 2 3 7

Rest: 45 s between setsCardio (run, bike, elliptical) 30-min high intensity

(low, mod,high HR)

30-min high intensity(low and high HR)

30-min high intensity(low, mod, and high HR)

30-min high intensity(low and high HR)

The MOV coach modified participants’ training loads such that the desired number of repetitions could be achieved with a maximal effort. Where applicable, exercises wereprogressed from unilateral to bilateral over the 12 weeks. The intensity of each cardio training session was monitored using participants’ heart rates as measured during their baselinefitness test. Exercises labeled with the same number (e.g., 1A, 1B, and 1C) were performed in succession before completing a second set. Range of motion (ROM) activities includedvarious low-intensity flexibility/mobility (e.g., hamstring stretch) exercises.

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EXERCISE-BASED PERFORMANCE ENHANCEMENT ... - Movement … · Exercise-based performance enhancement and injury preven-tion for firefighters: Contrasting the fitness- and movement-related